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23 July 2019

It should shame us that Aboriginal and Torres Strait Islander Australians have such poor health outcomes. They die 10 years younger and have much higher death rates than non-indigenous people across all age groups and for all major causes of death.

 

Heart disease, advanced cancer, diabetes and subsequent kidney failure, untreated blindness and childhood deafness are far too common. Cancer is diagnosed later and incomplete treatment is almost the norm. The rate of First Nations’ discharge against medical advice, an indicator of health systems’ successfully engaging patients, is eight times higher than for non-indigenous Australians. Despite employing Aboriginal liaison officers, hospitals are failing First Nations people.

 

Health messages are being ignored: 39 per cent of indigenous people smoke daily compared with 14 per cent of the Australian population. Consequently, heart disease is eight times higher in middle-aged indigenous Australians. The commonest cancers in First Nations people are lung and head and neck (mouth and throat), both smoking-related. Diabetes is three times more prevalent and chronic renal failure, an indicator of poor diabetes management, is five times higher.

 

 Last year’s Australian Medical Association report card on Closing the Gap highlights that health systems are designed for “equity of outcome”. But something is wrong when First Nations people are 10 times less likely to be added to a kidney transplant waiting list and 30 per cent less likely to be offered cataract surgery.

 

Health expenditure on those with greater needs should be higher. Combined public and private hospital costs of First Nations people with cancer and musculoskeletal disease (hip and knee replacements and so on) are lower than for non-indigenous Australians. The cost of mental and behavioural disorders, diabetes and injuries are higher.

 

The lower cost of orthopaedic and musculoskeletal services but higher rates of obesity and injuries reflect the lack of access to public health services. The higher rates of cancer but lower spend on cancer services for First Nations people is disgraceful.

 

We may pride ourselves on our multiculturalism, but “otherness” and pigeonholing are everywhere.

 

Assumptions by staff that the indigenous patient will not turn up for an operation mean they often are not placed on theatre lists. The reasoning that remote indigenous people will not arrive when a matched kidney donor becomes available at necessarily short notice may explain the one-tenth rate of indigenous people offered a place on transplant lists.

 

Indigenous people are slower to access medical services to investigate health complaints. The abdominal pain or rectal bleeding that signifies a possible bowel cancer is just too hard to investigate when you have to leave a safe environment and dependent children to travel many hours by car and then train or plane to a potentially unsafe hostel to be seen by white health professionals who don’t understand your thinking and culture. 

 

Then the assumption is often made that the appointments for investigations that may have long waiting lists and require other long journeys won’t be kept.

 

Canada and the US have similar indigenous health issues, although not as bad. Each is building First Nations hospital networks run by indigenous organisations for indigenous patients. The hospital is “culturally safe” in design and staffing. Cancer investigations are expedited, as are ear and eye surgeries that are relatively cheap and simple.

 

Diabetes and chronic renal failure with dialysis are treated in a sensitive environment that encourages engagement and participation. Indigenous hospitals can be training centres for indigenous employment from nursing to accounting and building maintenance. They can be places where non-indigenous health professionals are taught cultural sensitivity and about the health and emotional needs of our 800,000 First Australians.

 

St Vincent’s Healthcare Australia has allocated funding from its inclusive health program to test the viability and business case of a First Nations hospital and health network proposed for Inala in Brisbane. Its steering committee is led by Noel Hayman, Queensland’s first Aboriginal doctor and specialist public health physician. He is director of the Inala Indigenous Health Service, which is associated with the University of Queensland. He is being advised by Kelvin Kong, Australia’s first Aboriginal and Torres Strait Islander surgeon, and other respected and senior specialists.

 

There are 85,000 Aboriginal and Torres Strait Islanders living in the neighbourhood of the Inala centre. That is the population of Bundaberg, which has a 240-bed public hospital with five operating theatres and an endoscopy suite, along with three private hospitals with 10 operating rooms and four theatres for endoscopies.

 

It is envisaged the Inala health centre hospital will be a 23-hour hospital for indigenous patients to enable them to comfortably enter the hospital system. It will have the cancer surgeons and endoscopists to screen for the cancers that present in great numbers and are too advanced to cure. 

 

It will be a waiting list reduction hospital for non-indigenous people. It would be a culturally sensitive place with good, clean hostel accommodation next door. This Aboriginal hospital will screen for cancer of the lungs, bowel, throat and breast. Patients then can be referred directly to the major tertiary hospitals including Princess Alexandra, Logan and QEII, and the patients will be supported in that journey. The Inala First Nations hospital also can help patients in other areas where results are still poor — dental care, dialysis and palliative services.

 

If a sustainable model of care for indigenous Australians can be built in Inala, other indigenous hospitals could be built elsewhere. We have to close the gap. Spare capacity in these indigenous hospitals could be filled with the overflowing non-indigenous waiting list patients. Everyone’s a winner.

 

Planning for Inala makes the case that Australia can catch up with Canada and the US in addressing poor indigenous health outcomes with a well-funded indigenous hospital and health network. Now the community needs to face the challenge of funding the building and ensuring sustainable ongoing resourcing. We need equality of outcome in First Nations health to start to close the gap in education and economic outcomes. Today’s healthcare model fails them.

 

Christopher Perry is an associate professor at the University of Queensland. This essay was published in The Australian 3 July 2019